Adrenal Dz Flashcards
Hypofxn of gland involves
Blood supply and innvercation is
AI presentation depends on
hormones most important in sx
_____ are produced in other parts of the body, thus rarely cause sx
entire gland
homogenous (never single hormone def)
severity and hormone level
Aldo and cortisol
sex steroids
HyperFxn of gland
Each layer of adrenal gland is responsible for
hyperfxn can occur via
specific group of hormones
hyperplasia or hormone secreting tumor
Incidental tumor on imaging
must evaluate for
Acute adrenal insuff occurs due to
condition is, body cannot produce
Replacement of ____ necessary for organ perfusion/BP
can occur in pt w _____ w stressor
process
suspicious features, rule out hyperfxn
infarct/hemorrage
life threatening, adrenal hormones
cortisol
chronic insuff (AD)
cannot mount stress response- hypoTN and underperfused organs, cell damage
Addison’s dz (Primary adrenal insuff)- chronic
do caused by
results in the dec production of
typically presents
usually caused by
other etiologies
destruction of AC
hormones by gland
over time
AI Destruction
tb, HIV, metastatic/infiltrative dz
Sx of Addisons dz
F, worse w
M
W
N/V
Inc skin pigmentation due to
Hypo TN as a result from dec production of
results in
fatigue, stress
muscle weaness
wl
N/V
MSH, byproduct of ACTH
mineralocorticoids (aldo)
hypovolemic volume contraction
First step to eval Addisons
give pt synthetic _____, should result in production of
Inadequate response indicates
could be from
to differentiate, check
High ACTH indicates
Low indicates
Lab findings
Tx
ACTH (cosyntropin), cortisol
hypofxn
adrenal dz (primary), central dz (sec/tert)
morning ACTH level
adrenal gland problem
central problem
hypoNa/hyperK- low aldo dec Na reab w dec K sec
hypogly (dec cortisol induced gluco)
replace GC/MC
Hyperaldosteronism (Conns syndrome)
Primary cause
Secondary cause
Sx
Tx ____ to normalize BP/K
adrenal tumor w excess aldo (conns)
stimulation of aldo by renin in renal artery stenosis/CHF
HTN, hypoK
aldo receptor ag (spironolactone)
Hypercortisolism (Cushing)
MC cause is
additional cause
called
Sx
PE shows C, M, S, H, M, B
Infections can occur due to, as well as
iatrogenic (exogenous GC)
pituitary adenoma (Cushing Dz), adrenal adenoma, ectopic acth
oligomenorrhea, depression, weakness, Diabetes sx
central obesity, muscle wasting, skin bruising w ab striae, hirsutism, moon facies, buffalo hump
immunosuppresion, HTN
First line test for cortisol excess
once confirmed, use ___ to localize the lesion
if ACTH low, localized to
if high, perform ______ for follow up
large dose of DM should ____ cortisol levels in _____ but ectopic (ca) would not respond to ____ and be _____
24hr urine free cortisol level, low dose DM suppresion test, late night salivary cortisol
serum ACTH level
adrenal gland
pituitary/ectopic cause, high dose DM suppresion
suppress, PA, NF, high
Congenital adrenal hyperplasia
___ defic, resulting in inc products ____&_____ distal
leads to deficiency in ____ w or wo loss of ____
MC enzyme defect dec
loss of ____ on acth results in hypertrophy, as pituitary continues to
does not affect the ______, so extra ____ synth occurs
enzyme, proximal, dec
cortisol synth, MC synth
dec both MC/GC
NF of cortisol, stimulate gland to no avail
sex steroid path, androgen synth
CAH deficiency most common in
complete def aka
sx at _____, include S, h, h, M, H
steroid products are shunted to ____, causing viilation/ _____ in females
21 hydroxylase
neonatal salt wasting syndrome
birth, salt wasting, hypoNa, hyperK, Met Acid, hypoTN
androgen pathways, abiguous genitalia
Less complete CAH defic
classic ____ syndrome
some ___ is made
presents w
excess
virilizing
MC/GC
virilization (F) precocious puberty (M)
sex seroid
Nonclassic/late onset CAH
____ defic
majority of ___ is available
excess ___ builds over time, sx are
Tx aimed at
this provides _____ to brain/pituitary to reduce stimulation
gland does not hypertrophy, thus producing less
mild
MC/GC
adrenal androgens, milder
replacing GC/MC
NF, to adrenal gland
adrenal adrogens
Pheochromocytoma
secretes catecholamines in a short burst, resulting in
pateints present w
evaluation includes, these should be
tx starts w alpha agonist _____, which prevents
follow w
once a/b blockade has occured, _____ results in cure
episodic HTN
HTN, flushing, sweating, tachy
24 urine normetanephrine/metanephrine, elevated
phenoxybenzamine (prevtns unopposed alpha action)
beta blocker
surgical resection
Neuroblastoma
MC adrenal tumor in
occurs in the
malignant tumor from
occurs in children
preesents as
tx includes
children
AM/paraspinal region
NCC of SNS
<4
palpable, firm, irregular mass over midline
surgical resection
